On the psychology of psychiatrists

A reader asked:

I wonder if you could write something about the psychology of psychiatrists? If ever there was a profession that catered to sadistic sociopathy, it would have to be psychiatry. Absolute power to abuse on a whim, almost completely helpless victims, and an almost zero chance of ever being held accountable for inflicting endless cruelty and torture.

In a sermon in Westminster Abbey on March 20, 1925, the Rev. Frederick Donaldson discomforted his parishioners with this list of what he called the Seven Social Sins:

Wealth without work; Pleasure without conscience; Knowledge without character; Commerce without morality; Worship without sacrifice; Politics without principle; Science without humanity.

Did he have a time machine? A century later, nothing has changed except everything is now worse. Wealth without work? The richest people who have ever lived are all alive today (excluding kings like Leopold II). There are a billion people on earth whose personal wealth would not amount to $10.00, while some are worth $200billion (the richest woman on earth, L'Oreal heiress Francoise Bettencourt Meyers, just reached $100billion).

Commerce without morality? The major fossil fuel companies have known for fifty years that burning all deposits known at that stage would irreversibly damage the world's climate, yet they concealed the evidence and actively engaged in paying people to deny the possibility of climate change. Same as the cigarette and asbestos companies, same as the people who pushed "non-addictive opiates," leading to 80,000 deaths a year in the US alone (2021). Politics without principle? Where do we start? Just turn on the TV, it's all there. Worship without sacrifice? The Reverend gentleman had obviously never heard of what's called Prosperity Gospel but we'll leave that abomination for another day.

Last but not least, science without humanity. This is a little problematic as many scientists will tell you: "Humanity has nothing to do with our work, ours is the disinterested pursuit of knowledge for knowledge sake. What people do with our results is up to them, not us." Robert Youngson stitched this up in his fascinating little book, Scientific blunders: "The idea that (scientists) are engaged in a calmly disinterested search for truth and are totally unaffected by such unworthy considerations as personal pride, competitiveness and envy is a dream of adolescent idealism" [1]. How does this work out in practice?

We can start with the obvious, the numbers of people trained as scientists who are directly working to develop weapons and military technology whose only purpose is to kill other people and to destroy their cities and farms. How many, I don't know, nobody knows, these are closely-guarded secrets but in the US alone, it would have to be a quarter of a million people. These are not just workers studying new explosives or working out how to make battle tanks invisible to radar, but all the people working on spy satellites, or how to jam the enemy's drones and so on. Then there are autonomous battle robots that will simply be programmed and let loose; the technology to develop autonomous cars and taxis is actually an offshoot of this work, it's the public face of a totally sinister project. These days, of course, IT is a huge military industry in its own right, working out how to spy on everybody and to block their efforts at spying back. Add to that the banks that finance all of this activity by keeping the military manufacturers in business. There is nothing dispassionate in it, they know exactly what they're doing: I'm constantly getting drooling emails telling me to invest in weapons companies.

Add to these all the engineers who actually design and build the weapons and war machines the scientists have dreamed up, say half a million; then there are the technicians on the factory floor, say two million ... suddenly, it's starting to look like big business. And this is multiplied around the world. But if you were to accuse any of these people of complicity in mass murder, they would be most offended yet that's the case. Theirs is science without humanity. Sure, if we didn't have the technology, there would still be wars but Hiroshima, Dresden, Fallujah, Gaza City and so many other devastated places would still be standing, their citizens quietly going about their humdrum lives and their kids trotting off to school. You can't do much damage with a lump of wood. Science has magnified the danger that humans represent to their neighbours to the extent that a small group of people have the power to end the world as we know it in an eyeblink, perhaps even end all life itself. The idea that an idiot like Trump could have had his stubby fingers poised over the nuclear button should be enough to keep every person on the planet awake all night, and it's all because of science without humanity, politics without principle.

But back to psychiatry. The reader said: "If ever there was a profession that catered to sadistic sociopathy, it would have to be psychiatry." The Irish-born author and lay theologian, Clive Staples Lewis, thought about this a lot:

Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. Their very kindness stings with intolerable insult. To be ‘cured’ against one’s will and cured of states which we may not regard as disease is to be put on a level with those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals. But to be punished, however severely, because we have deserved it, because we ‘ought to have known better’, is to be treated as a human person made in God’s image.

To be "cured of states which we may not regard as disease" by "moral busybodies ..." Hmm, that's starting to sound like psychiatry, but to clear up one point: there would be very, very few psychiatrists who meet the definition of "sociopathic/antisocial personality disorder." How come? Well, who wrote the definition? Psychiatrists, of course, and they're not going to define it to include themselves [2]. Physical aggression and impulsive law-breaking are a big part of the definition and most psychiatrists are physically unimpressive and also fearful of breaking the law. However, we talked about psychopaths recently, re Henry Kissinger (Substack Dec. 5th), and the central feature of that outmoded diagnosis was: callous indifference to other people's interests and emotions. So the commandant of Auschwitz extermination camp, Rudolph Höss, was a psychopath but emphatically not a sociopath. He followed rules very closely, was polite, scrupulously tidy and organised, and was a good family man who enjoyed company. For him, removing inferior humans from the gene pool was no different than exterminating an infestation of rats. That was what made him dangerous. The essence of the psychopath is total indifference to the humanity of other people.

This tells us to look at people, not from the obvious, superficial point of whether they lose their temper and punch the nearest person, but whether, calmly and in clear consciousness, they sit down and plan to work against another person's interests without asking whether they ought to do this. That puts a different light on it. How many psychiatrists get drunk, steal a car and smash it, pick up a chair and knock their spouses to the ground, steal from the local golf club or parish committee, sexually abuse their children and so on? I'm not the best person to answer that because I hardly know any psychiatrists but I'd say it's very few, just because if that's how you behave, you won't get through medical school. But if you ask: How many psychiatrists "follow rules very closely, are polite, scrupulously tidy and organised, and are a good family people who enjoy company" whose "very kindness stings with intolerable insult"? then the answer is "heaps."

How many psychiatrists are in it just for the money? Probably very few, but if the question is how many "sincerely exercise a tyranny for the good of their patients" which just happens to bring in heaps of money, then the answer is "lots." And the more money it brings in, well, the more sincerely they believe they're doing the right thing. Of course they do. It's called positive reinforcement and psychologist BF Skinner worked it out seventy years ago - with rats. We see it with ECT. Psychiatrists who use ECT will all say how wonderful it is, how safe and effective and such a godsend that they can give it to misguided souls who actually don't want it. And it pays, of course, about $220 for a few minutes of pressing something against an unconscious person's head, about as intellectually demanding as opening a can of beer. So Australia uses lots of ECT, near the top of the international scale, whereas in Norway, where only government psychiatrists are allowed to give it, it's hardly used because organising it is too much drama and paperwork. Same as in New Zealand, which has very few private psychiatrists, so they give it at one sixth of the rate as Victoria, which has swarms of underemployed private psychiatrists jockeying for work. As for the safety of ECT, check this report from a victim.

How many psychiatrists genuinely believe they're doing the right thing for their patients, even if said patients experience it as "endless cruelty and torture"? All of them. There would be a few with the insight to know that their "treatment" is resented but that's tough, the patient is a prick anyway so if he doesn't pull his head in, he'll get a double dose. And as we all know, giving a patient the label "psychopath" is a licence for everybody to treat him psychopathically.

But that conceals a crucial point: How many psychiatrists actually know what they're doing? If you look at the RANZCP website, Position Statement No. 80, from 2013, "Psychiatry training," states: "This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being." Regular readers will recall that I wrote to the president of RANZCP (Substack Nov 28th) asking for details of their "biopsychosocial model." On November 20th, she replied:

The (biopsychosocial model) remains the predominant theoretical framework underpinning contemporary psychiatry and remains a relevant and useful component of training and practice.

Thank you, doctor, for this revealing letter but I actually asked for specific references to the material that is used in training, like what's on the handouts, what do you tell them to read? I replied to her curt response with a much longer, more detailed and more tersely-worded request for that material but haven't heard back. I don't expect to because I know, and you know, and she knows, and she knows we know, that the reason she has suddenly gone quiet is because they don't actually have this material. Their "predominant theoretical framework" is all make-believe, a fabrication designed to make themselves feel better, to fool the general public and the regulatory and funding bodies, and, above all, to sort trainees into two groups: the nice ones who are easily gulled into believing what they're told, and those obstreperous little pricks who actually ask pointed questions. The former group are guided through the training process to the graduation ceremonies (you can see a heart-warming picture of one on the RANZCP website) and into cushy jobs in academia and private practice, while the latter are squeezed until they decide they'd rather be country GPs instead.

Back to the reader's question: Do I have anything on the psychology of psychiatrists? No. I'll ask around but doubt very much if any psychiatrists would participate in such a project (especially if it were run by psychologists) or, if they did, they would answer honestly. Are a significant proportion of psychiatrists psychopathic? Again, I hardly know any so I'm not the best person to ask but I doubt it (Joseph Biederman was but he was fairly exceptional, we'll talk about him another day). Do a significant proportion of psychiatrists act in a psychopathic manner? If psychopathic means callous and indifferent, the answer is a firm yes. Do they believe they are? No, they don't, they all think they're wonderfully kind and caring people who treat firmly when necessary ("like a surgeon lancing an abscess") as guided by their all-embracing, all-revealing biopsychosocial model.

That's nice, can we have a copy?

No, piss off, you obstreperous little prick.

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References:

1. Youngson R (1998). Scientific blunders: a brief history of how wrong scientists can sometimes be. London: Robinson.

2. DSM5, American Psychiatric Association (2013), p764-5.

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